Paper
Friday, July 15, 2005
Pressure Ulcers: Development and Validation of a Prediction Rule
Lisette Schoonhoven, PhD, RN1, Erlgard Van Kol, MSc, RN2, Erik Buskens, PhD, MD2, and Theo Van Achterberg, PhD, RN1. (1) Centre for Quality of Care Research, Nursing Science Section, Radboud University Nijmegen Medical Center, Nijmegen, Gelderland, Netherlands, (2) Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| Learning Objective #1: Put use of risk assessment scales in perspective |
| Learning Objective #2: Name independent predictors of pressure ulcers in hospitalized patients |
Background: Patients admitted to hospital are at risk for the development of pressure ulcers. Risk assessment scales are used to detect high risk patients in need of preventive measures. However, the most commonly used risk assessment scales do not predict pressure ulcers satisfactorily in hospitalized patients. Therefore, we set out to identify independent predictors for development of pressure ulcers in hospitalized patients and developed and validated a simple prediction rule for pressure ulcer development. Design: Two prospective cohort studies were performed in 4 hospitals in the Netherlands. Data from the first study were used to develop a new prediction rule which was externally validated using data from the second study. Patients: 1229 and 1440 patients admitted to the surgical, internal, neurological and geriatric wards were included in the two studies, respectively. Main outcome measures: Occurrence of a pressure ulcer grade 2 or worse during admission to hospital. Results: Independent predictors of pressure ulcers were: age, weight at admission, abnormal appearance of the skin, friction and shear, and planned surgery in coming week. The area under the curve of new prediction rule was 0.70. At a cut-off score of 20, 42% of the patient weeks were identified as at risk for pressure ulcer development, thus correctly identifying 70% of the patient weeks in which a pressure ulcer occurred. The area under the curve in the second study was 0.69, and 64% of the patient weeks in which a pressure ulcer occurred were correctly identified. Conclusion: A simple clinical prediction rule based on five patient characteristics may help to identify patients at increased risk for pressure ulcer development, and in need of preventive measures.